Uterine Fibroids

Uterine fibroid symptoms and the treatment to relieve chronic pelvic pain, heavy menstrual bleeding and other symptoms of fibroid tumors

• What are uterine fibroids?
• Who is most likely to have uterine fibroids?
• What are typical uterine fibroid symptoms?
• How are uterine fibroids diagnosed?
• How are uterine fibroids treated?
• Uterine fibroid treatment risks

What are uterine fibroids?

Fibroid tumors are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women including pain and heavy bleeding. They typically improve after menopause when the level of estrogen, the female hormone that circulates in the blood, decreases dramatically. However, menopausal women who are taking supplemental estrogen (hormone replacement therapy) may not experience relief of symptoms.

Uterine fibroids – also called myoma, leiomyoma, leiomyomata and fibromyoma – range in size from very tiny to the size of a cantaloupe or larger. In some cases, they can cause the uterus to grow to the size of a 5-month pregnancy or more. Fibroids may be located in various parts of the uterus.

There are 3 primary types of uterine fibroids:

• Subserosal fibroids, which develop in the outer portion of the uterus and expand outward. They typically do not affect a woman’s menstrual flow but can become uncomfortable because of their size and the pressure they cause.
• Intramural fibroids, which develop within the uterine wall and expand, making the uterus feel larger than normal. These are the most common fibroids. This can result in heavier menstrual flows and pelvic pain or pressure.
• Submucosal fibroids are deep within the uterus, just under the lining of the uterine cavity. These are the least common fibroids, but often they cause symptoms including very heavy and prolonged periods.

Who is most likely to have uterine fibroids?

Uterine fibroids are very common, although often they are very small and cause no problems. From 20 to 40 percent of women age 35 and older have uterine fibroids of a significant size. African American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size.

What are typical symptoms?

Depending on location, size and number of fibroids, they may cause heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots. This often leads to anemia. There are several signs and symptoms of fibroid tumors.

• Chronic pelvic pain
• Pelvic pressure or heaviness
• Pain in the back or legs
• Pain during sexual intercourse
• Bladder pressure leading to a constant urge to urinate
• Pressure on the bowel, leading to constipation and bloating
• Abnormally enlarged abdomen

How are uterine fibroids diagnosed?

Fibroids are usually diagnosed during a gynecologic internal examination. Your doctor will conduct a pelvic exam to feel if your uterus is enlarged. The presence of fibroids is most often confirmed by an abdominal ultrasound. Fibroids also can be confirmed using magnetic resonance (MR) and computed tomography (CT) imaging techniques. Ultrasound, MR and CT are painless diagnostic tests. Appropriate treatment depends on the size and location of the fibroids, as well as the severity of symptoms.

How are uterine fibroids treated?

Most fibroids do not cause symptoms and are not treated. When they do cause symptoms, a drug therapy often is the first step in the treatment for fibroids. This might include a prescription for birth-control pills or other hormonal therapy, or the use of non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen sodium. In many patients, symptoms are controlled with these fibroid tumor treatments and no other therapy is required. Some hormone therapies do have side effects and other risks when used long-term so they are generally used temporarily. Fibroids often grow back after therapy is discontinued.

The next step is to try more invasive therapy. The most common treatment options are listed below.

• Minimally Invasive Treatment
  Uterine Fibroid Embolization - A minimally invasive procedure, which means it requires only a tiny nick in the skin. It is performed while the patient is conscious but sedated – drowsy and feeling no pain. Studies show that up to 90 percent of women who have the procedure experience significant or total relief of heavy bleeding, pain, and other symptoms. The procedure also is effective for multiple fibroids. Read more…
  
  
• Surgical Treatment
  Myomectomy – A surgical procedure that removes visible fibroids from the uterine wall. Myomectomy leaves the uterus in place and may, therefore preserve the woman’s ability to have children. While myomectomy is frequently successful in controlling symptoms, the more fibroids there are in a patient’s uterus, generally, the less successful the surgery. Read more…
  
  Hysterectomy – An open surgical procedure where the uterus is removed. This operation is considered major surgery and is performed while the patient is under general anesthesia. Hysterectomy is the most common current therapy for women who have fibroids. It is typically performed in women who have completed their childbearing years or who understand that after the procedure they cannot become pregnant. Read more…

Uterine fibroid treatment risks

Uterine Fibroid Embolization is considered to be very safe. However, there are some associated risks, as there are with almost any medical procedure. Most women experience moderate to severe pain and cramping in the first several hours following the procedure. Some experience nausea and fever. These symptoms can be controlled with antibiotics. It also has been reported that there is a 1% chance of injury to the uterus, potentially leading to hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy.

A small number of patients have entered into menopause after embolization. This is more likely to occur if the woman is in her mid-forties or older, and is already nearing menopause.

Myomectomy and hysterectomy also carry risks including infection and bleeding leading to transfusion. Patients who undergo myomectomy may develop adhesion's causing tissue and organs in the abdomen to fuse together, which can lead to infertility. In addition, the recovery time is much longer for abdominal myomectomy, generally 1 to 2 months.

You should talk with your doctor about possible risks of any procedure you may choose.

If you think you have fibroids, please consult your physician or call 865.305.6970 or and let us make an appointment for you.

Related Readings:

• Uterine fibroids and hysterectomy
  
• Hysterectomy Surgery
• Infertility in women
• Menstrual Disorders
• Menopause
• Osteoporosis